RESUMO
An 8-month-old female presented with hydrocephalus caused by cerebrospinal fluid (CSF) overproduction due to bilateral choroid plexus enlargement, which was clinically diagnosed as diffuse villous hyperplasia of the choroid plexus, but differentiation from bilateral choroid plexus papilloma was difficult. She initially underwent ventriculoperitoneal shunt surgery, but developed marked retention of ascites. Therefore, the peritoneal end of the shunt was removed for external drainage, but excessive CSF (1,500 ml/day) was collected. Computed tomography and magnetic resonance imaging revealed marked symmetric enhancement of the choroid plexuses in the bilateral lateral ventricles. Thallium-201 chloride single-photon emission computed tomography showed pronounced uptake on both early and delayed images, and good washout. CSF examination revealed no abnormalities such as atypical cells, and a ventriculoatrial shunt was inserted, achieving good control of the hydrocephalus.
Assuntos
Neoplasias do Sistema Nervoso Central/patologia , Derivações do Líquido Cefalorraquidiano/métodos , Plexo Corióideo/patologia , Hidrocefalia/cirurgia , Ventrículos Laterais/irrigação sanguínea , Papiloma do Plexo Corióideo/patologia , Neoplasias do Sistema Nervoso Central/cirurgia , Líquido Cefalorraquidiano/metabolismo , Derivações do Líquido Cefalorraquidiano/instrumentação , Feminino , Humanos , Hidrocefalia/etiologia , Hiperplasia/complicações , Lactente , Ventrículos Laterais/metabolismo , Ventrículos Laterais/patologia , Microvilosidades/patologia , Papiloma do Plexo Corióideo/cirurgia , Resultado do TratamentoRESUMO
Marked depression of the skin flap after external decompressive craniotomy, affecting the brain function, is known as sinking flap syndrome. However, to our knowledge, there have been no reports of delayed sinking of the entire bone flap after the procedure, inducing neurological symptoms. We encountered a patient with neurological symptoms due to sinking of the entire bone flap 15 years after the first operation. A 59-year-old male underwent clipping by craniotomy due to subarachnoid hemorrhage resulting from the rupture of a left internal carotid aneurysm 15 years earlier. He was discharged, but developed paresis in the right upper and lower limbs 6 months before symptom onset. CT showed sinking of the free bone flap, while MRI revealed left uncal herniation. After uncal resection and free flap fixation, the symptoms improved. This case confirmed the necessity of firm bone flap fixation at the time of cranial closure.
